STACY PARK (NPI# 1205290459) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205290459 |
| Entity Type | Individual |
| Full Name | STACY PARK |
| Practice Address |
635 E Baseline Rd Phoenix AZ 85042-6551 |
| Mailing Address |
4225 E Mcdowell Rd 1103 Phoenix AZ 85008-7475 |
| Practice Telephone | 6022437277 |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2016-04-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | S020120 | AZ | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346841475 | Stacy Shoemake Park | Pharmacist | 6435 Bells Ferry Rd, Woodstock, GA 30189-2317 | 2020-11-04 |
| 1992961197 | Stacy Park | Social Worker | 1730 W Olympic Blvd Fl 3a-100, Los Angeles, CA 90015-1019 | 2008-08-06 |
| 1205012234 | Stacy Lynn Park | Nurse Practitioner | 721 Glenwood Dr, Suite 462a, Chattanooga, TN 37404-1106 | 2008-01-22 |
| 1326115916 | Stacy Prince Park | Social Worker | 240 W Tyrone Rd, Oak Ridge, TN 37830-6517 | 2006-11-29 |
| Street Address |
635 E BASELINE RD |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85042-6551 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164414892 | Neil Trachtenberg | Obstetrics & Gynecology | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2005-08-18 |
| 1548884240 | Heather E Weninger | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2020-05-29 |
| 1245863786 | Katherine Marie Bear | Nurse Practitioner | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2020-02-12 |
| 1841821642 | Manyil Dashe | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2020-01-30 |
| 1962045112 | Natasha Burrell | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2019-10-21 |
| 1215404652 | Heather Diane Hargrave | Physician Assistant | 635 E Baseline Rd, Phoenix, AZ 85042 | 2018-10-24 |
| 1700351475 | Robert Eugene Carter | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2018-10-09 |
| 1134605132 | Philsy Jaison | Nurse Practitioner | 635 E Baseline Rd, Phoenix, AZ 85042-6583 | 2018-07-13 |
| 1891208948 | Samantha Thompson | Pharmacist | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2017-11-12 |
| 1295259075 | Evelyn Coronado | Dietitian, Registered | 635 E Baseline Rd, Phoenix, AZ 85042-6551 | 2017-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443197 | Da Homes LLC | Case Management | 8026 S. 24th Way, Phoenix, AZ 85042 | 2020-10-05 |
| 1144790460 | Ebony House Inc | Substance Abuse Rehabilitation Facility | 6222 S. 13th Street, Phoenix, AZ 85042 | 2018-11-29 |
| 1427538362 | Abigail Mcgrath | Dietitian, Registered | 303 E Baseline Rd Ste 200, Phoenix, AZ 85042 | 2018-08-20 |
| 1174028310 | Olufemi A Omodara | Pharmacist | 7227 S. Central Ave, #1080, Phoenix, AZ 85042 | 2018-03-29 |
| 1720537699 | Mary Youngblood | Registered Nurse | 7210 S 27th Way, Phoenix, AZ 85042 | 2016-10-03 |
| 1922490382 | Brian Zembower | Optometrist | 610 E Baseline Rd Ste C3, Phoenix, AZ 85042 | 2015-02-23 |
| 1417299819 | Robert Murphy Portley | Psychiatry & Neurology | 2320 E Baseline Rd Ste 148-225, Phoenix, AZ 85042 | 2013-03-23 |
| 1972807998 | Obinna Chukwuka Akubukwe | Pharmacist | 6006 S. Central Avenue, Phoenix, AZ 85042 | 2011-01-05 |
| 1104120328 | Gisheys Patient Care LLC | Custodial Care Facility | 7232 South 12th Place, Phoeniz, AZ 85042 | 2011-01-03 |
| 1245463488 | Lois Ann Hammitt | Registered Nurse | 6218 S. 7th Street, Phoenix, AZ 85042 | 2009-09-03 |
| Find all providers in zip 85042 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386243848 | Stephen Praissman | Pharmacist | 3101 E Claremont Ave, Phoenix, AZ 85016-2361 | 2020-10-25 |
| 1356949929 | Teresa Louise Cox | Pharmacist | 1800 E Van Buren St., St. Luke's Behavioral Health, Phoenix, AZ 85006 | 2020-10-15 |
| 1760097703 | Cindy Ryanto | Pharmacist | 39508 W Daisy Mountain Dr, Phoenix, AZ 85086 | 2020-09-15 |
| 1689288037 | Akeel Daher | Pharmacist | 28635 N N Vly Pkwy, Phoenix, AZ 85085-5434 | 2020-09-03 |
| 1295346401 | Ann Michelle Mason | Pharmacist | 1511 E Renee Dr, Phoenix, AZ 85024-2973 | 2020-08-11 |
| 1053921767 | Vera Benson | Pharmacist | 1219 E Villa Maria Dr, Phoenix, AZ 85022-1222 | 2020-08-06 |
| 1154947133 | Justin Gerard Spicer | Pharmacist | 1 E Lexington Ave, Phoenix, AZ 85012-2433 | 2020-06-24 |
| 1518582501 | Davita D Lewis | Pharmacist | 2532 W Peoria Ave, Phoenix, AZ 85029-4709 | 2020-06-15 |
| 1518582683 | Thomas Komlos | Pharmacist | 18224 N Clemmer Ln, Phoenix, AZ 85022-1306 | 2020-06-14 |
| 1063037554 | Chezka Mae Largosa Baker | Pharmacist | 800 N Central Ave Apt 1218, Phoenix, AZ 85004-2777 | 2020-06-10 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.